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Clinical Knowledge 2 > Periodontitis and Systemic Health > Flashcards

Periodontitis and Systemic Health Flashcards

1
Q

What is an association?

A

a correlation observed between many variables but causation cannot be determined

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2
Q

What is a causation?

A

change in one variable will produce a change in another variable

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3
Q

Outline systemic conditions which have been linked to periodontal disease with a strong evidence base

A

Cardiovascular disease
diabetes
adverse pregnance outcomes

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4
Q

Outline systemic conditions which have been linked to periodontal disease with a weak evidence base

A

obesity
respiratory disease (COPD, pneumonia)
CKD
Rheumatoid arthritis
cognitive impairment
metabolic syndrome
cancer

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5
Q

What hormones are implicated in vascular changes observed in pregnancy? What are these vascular changes?

A

progesterone
oestrogen

they cause increased vascular permeability

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6
Q

What is the implication of vascular changes observed in pregnant women on periodontal disease?

A

increased vascular permeability along with plaque can cause inflammation

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7
Q

What oral health complications are observed during pregnancy ?

A

pregnancy gingivitis
pregnancy epulis

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8
Q

What is a pregnancy epulis?

A

severe swelling of the gums

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9
Q

What are the risk factors for pregnancy complications?

A
  • young mothers <18
  • genito-urinary infections
  • periodontitis
  • drug or alcohol abuse
  • maternal stress
  • genetics
  • idiopathics
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10
Q

Give examples of pregnancy complications

A
  • low birth weight <2.5kg
  • pre-term birth - birth before 32 weeks
  • growth restrictions
  • pre-eclampsia - maternal hypertension and proteinuria
  • miscarriage or still birth
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11
Q

What pregnancy complications are associated with periodontitis?

A
  • low birth weight
  • preterm birth
  • pre-eclampsia
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12
Q

Outline the possible mechanism for pregnancy complications due to periodontitis

A

presence of periodontal bacteria in foetal-placental unit which may initiate an inflammatory response leading to adverse outcomes

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13
Q

What is the management of gingivitis in pregnant women?

A

OHI and PMPR

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14
Q

What is the management of periodontitis in pregnant women?

A

OHI and PMPR

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15
Q

What is the management of epulis in pregnant women?

A

delay plans to excise. May need to do cleaning

Re-evaluate need for surgical option post partum as it may resolve

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16
Q

What is the management of oral surgery in pregnant women?

A

avoid during pregnancy

delay until delivery

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17
Q

What are the oral complications of diabetes?

A
  • xerostomia
  • opportunistic infection
  • caries
  • delayed wound healing
  • oral parasthesia
  • susceptibility to perdiodontal disease
  • altered taste sensation
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18
Q

What are the disease processes associated with chronic hyperglycaemia?

A
  • retinopathy
  • neuropathy
  • nephropathy
  • micro and macro vascular disease
  • impaired wound healing
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19
Q

Diabetics with poor glycaemic control have a _____ fold increased risk of developing periodontitis

A

three fold increased risk of developing periodontitis

20
Q

What test can give an indication of long term glycaemic control?

A

HbA1c

21
Q

What kinds of periodontitis patients are at a risk of developing diabetes?

A

those with higher levels of HbA1c

22
Q

Patients with T2DM with periodontitis are more likely to experience diabetic complications. True or false

A

true

23
Q

What factors contribute to the risk of developing periodontitis in diabetic patients?

A
  • PMNL functions
  • Collagen metabolism
  • Advanced glycation end-products
24
Q

How is PMNL function affected in diabetes?

A
  • impaired chemotaxis, phagocytosis and adherence
  • PMNL defects may be inherited or secondary to hyperglycaemia
25
Q

How is collagen metabolism affected in patients with diabetes?

A

diabetics synthesis less collagen
diabetics also have higher levels of PMNL collagenase which breaks down collagen

smoking affects fibroblasts; collagenase also affected in smoking

26
Q

Outline the impact of AGE products in the pathogenesis of periodontitis in diabetic patients

A
  • in hyperglycaemic environments AGE formation increases
  • AGE produces cause collagen cross linking (covalent bonds between collagen and other fibrils)- reducing solubility/turnover of collagen
  • reducing solubility/turnover of collagen means that there is impaired wound healing
  • monocytes also have receptors for AGE- RAGE (receptors)- when AGE binds to RAGE, release of pro-inflammatory cytokines such as IL-1, IL-6 and TNFa are released
  • would healing ( due to compromised collaged solubility and increased collagenase removal of newly formed collagen) compromised
27
Q

How do you manage periodontitis in diabetic patients?

A
  • advise patient about increased risk of periodontal disease
  • collect detailed diabetic history
  • review MH
  • maintain periodontal health
    *advice
  • tailored OHI
  • diet advice
  • smoking cessation if applicable
  • PMPR as indicated
28
Q

Briefly outline the association between the glucose metabolism and the changes to the periodontal microbiome

A
  • recent studies show an association with altered glucose metabplism and periodontal microbiomer
  • no causal relationship has been developed
29
Q

Improving control of diabetes can result in improvements in periodontal status. True or false

A

true

30
Q

Improving periodontal health can result in the improvement of metabolic control and/or complications of diabetes. True or false

A

true

31
Q

Atherosclerotic cardiovascular diseases (ACVDs) include …

A
  • coronary heart disease- MI, angina
  • ischaemic cerebrovascular disease- stroke, TIA
  • peripheral vascular disease
32
Q

Periodontitis is a chronic inflammatory condition, if left untreated it can result in…

A

exarcebation of inflammatory conditions including ACVDs

33
Q

Outline a plausible mechanism for the periodontal relationship with CVD

A
  • chronic oral infection –> bacteraemia –> host response/inflammation –> athero-thrombotic lesion
34
Q

There is _______ evidence base that CVD is a risk factor for periodontitis

A

limited

thought is was strong?

35
Q

What kind of treatment can induce bacteraemia?

A

periodontal treatment

36
Q

CRP is used to measure …

A

inflammation

good measure for future ACVD as higher levels of CRP are associated with increased risk of cardiovascula events

37
Q

How should you manage periodontitis with patients who have CVD?

A
  • staged periodontitis treatment
  • multiple visitis area advised
  • liaise with cardiologist
  • patienst with perio and other risk factors such as HTN, smoking or obesity who have not seen their GMP for over a year should book a cardiac review
38
Q

Why are multiple visits advised for perio patients with CVD?

A

treatment is associated with transient impairement of endothelial function a week after

39
Q

What is the recall for periodontal monitoring for patients with CVD with no periodontitis?

A

regular periodontal monitoring at least every 12 months

40
Q

Poor diet/nutrition is a _______ variable for the development of periodontitis

A

confounding

41
Q

There is currently no proven link between osteoporosis and periodontitis. True or false

A

true

42
Q

What is the current evidence for links between rheumatoid arthritis and periodontitis?

A

some evidence that periodontitis may contribute to pathogenesis of RA however longitudinal study required to clarify association

43
Q

What is an important factor for the prevention of hospital acquired pneumonia, especially in patients on ventilators?

A

improved oral hygiene

44
Q

What are the difficulties with establishing associations/links between CKD and periodontitis

A
  • complex pathogenesis
  • links with diabetes and other conditions
45
Q

Recent meta-analyses consistently show a ________ association between obesity and periodontitis

A

statisitically significant positive

however few studies included are longitudinal thus overall effect appears to be modest

46
Q

Why are studies into possible associations between periodontitis and cancer difficult?

A
  • unable to control confounding factors such as smoking and socio-economic status
47
Q

Periodontitis has been identified as a possible risk factor for what kinds of cancers? (further long- term follow up studies are still needed)

A

pancreatic cancers
oro-digestive cancers

Clinical Knowledge 2 (40 decks)

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